Long-term Monitoring of Health Inequalities: Headline Indicators - October 2013

Annex 1: Indicator Definitions & Sources

• Healthy Life Expectancy

Source: ScotPHO (using raw deaths data from the National Register of Scotland); Scottish Household Survey data on self-assessed health for adults aged 16+ years [data for 2003/04 not available]; Census 2001 data for self-assessed health for those aged <16 years).

Definition: Healthy life expectancy (HLE) is defined as the number of years people can expect to live in good health. The discrepancy between healthy and total life expectancy (LE), therefore, indicates the length of time people can expect to spend in poor health. HLE is calculated through a combination of life expectancy and survey data on people's own assessments of their health. The method used to calculated the Life Expectancy estimates is based on Chiang (II) methodology; the HLE calculation is based on the Sullivan method. The uncertainty around estimates of HLE are larger than those around life expectancy because relatively small samples are involved in the age and sex specific breakdowns of survey data required to calculate HLE.

Change to methodology: In 2009, the format of the self-assessed health question (on which the life expectancy data is based) was changed to align with the European Union. The options for response changed from a three-point scale (Good, Fairly good, Not good) to a five point scale (Very good, Good, Fair, Bad, Very bad). Under the three-point scale 'Good' and 'Fairly good' were categorised as 'healthy'. Under the five point scale only 'Very good' and 'Good' are categorised as 'healthy'. This has led to a major discontinuity in the series. For both men and women, there is a markedly lower estimate of HLE at birth from 2009 than previous years.

• Premature Mortality (from all causes, aged under 75 years)

Source: National Records of Scotland.

Definition: European age-standardised rates of deaths from any cause amongst those aged under 75 years.

• Mental Wellbeing (adults aged 16 years and over)

Source: Scottish Health Survey (2008-2012).

Definition: Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). This has been developed as a tool for measuring positive mental wellbeing at a population level. The scale comprises fourteen separate statements describing feelings related to mental wellbeing; respondents are asked to indicate how often they have felt such feelings over the last two weeks. Results are presented as average WEMWBS score for the population concerned, and have been age-standardised for the first time in the 2013 report for each year in the time series.

• Low birthweight

Source: NHS Information Services Division (ISD); SMR02 maternity dataset.

Definition: The figures are presented as a percentage of all live, full term, singleton births (not including home births or births in non-NHS hospitals). Low birth birthweight is defined as <2,500g - the standard World Health Organisation definition. Figures for the most recent year are provisional.

• Healthy birthweight

Source: NHS Information Services Division (ISD); SMR02 maternity dataset.

Definition: A baby is considered to be of healthy birthweight (a weight appropriate for its gestational age) when it lies between the 5th and 95th centile for weight at its gestational age. Gestational age is a way of expressing the age or development of a baby. It is typically based on an antenatal ultrasound scan. However, it may also be estimated from the number of weeks since the mother's last normal menstrual period. Centiles for birthweight charts for gestational age are derived from Scottish data on births between the years 1998 and 2003^[10].

• Coronary Heart Disease - first ever hospital admission for heart attack aged under 75 years

Source: NHS Information Services Division (ISD) ; SMR1/01 records (all inpatient and daycase discharges) - all records were extracted from the SMR01 linked database as at 28th July 2012.

Definition: European age-standardised rates of first ever hospital admission for acute myocardial infarction (heart attack) amongst those aged under 75 years. The following World Health Organisation International Classification of Disease coding was used: ICD10 'I21-I22'; ICD9 '410'.

• Coronary Heart Disease - deaths aged 45-74 years

Source: NHS Information Services Division (ISD); using deaths data from National Records of Scotland.

Definition: European age-standardised rates death from coronary heart disease amongst those aged 45-74 years. The following World Health Organisation International Classification of Disease coding was used: ICD10 'I20-I25'; ICD9 '410-414'. Because of the dynamic nature of the linked database, previous years' data are sometimes updated in subsequent publications.

• Cancer - incidence rate aged under 75 years

Source: NHS Information Services Division (ISD); Scottish Cancer Registry.

Definition: European age-standardised rates of new cases of cancer amongst those aged under 75 years.

All Cancers- cancer defined as all malignant neoplasms excluding non-melanoma skin cancer. The following World Health Organisation International Classification of Disease coding was used: ICD10 'C00-C96' excluding 'C44' (the Scottish Cancer Registry does not use code 'C97').
Prostate cancer (males only)- ICD-10 C61
Breast cancer (females only)- ICD-10 C50
Cancer of the trachea, bronchus and lung- ICD-10 C33-C34
Colorectal cancer- ICD-10 C18-C20

• Cancer - deaths aged 45-74 years

Source: NHS Information Services Division (ISD); Scottish Cancer Registry.

Definition: European age-standardised rates of deaths from cancer amongst those aged under 45-74 years.

All cancers- cancer defined as all malignant neoplasms excluding non-melanoma skin cancer. The following World Health Organisation International Classification of Disease coding was used: ICD10 (2000 onwards) 'C00-C97' excluding 'C44'.
Prostate cancer (males only)- ICD-10 C61
Breast cancer (females only)- ICD-10 C50
Cancer of the trachea, bronchus and lung- ICD-10 C33-C34
Colorectal cancer- ICD-10 C18-C20

• Alcohol - first ever hospital admission aged under 75 years

Source: NHS Information Services Division (ISD).

Definition: European age-standardised rates of first ever hospital admission for alcohol related conditions amongst those aged under 75 years. These rates include hospitals discharges where alcohol-related problems are recorded as either primary or secondary reasons for admission to hospital and will cover first ever admission since 1981 (a patient may have had admissions prior to 1981 which would not be recorded in this database). These figures exclude private hospitals, mental illness hospitals, psychiatric units and maternity hospitals and include Scottish residents only. Caution is necessary when interpreting these figures. The recording of alcohol misuse may vary from hospital to hospital. Where alcohol misuse is suspected but unconfirmed it may not be recorded by the hospital. The following revised World Health Organisation International Classification of Disease coding was used: ICD10: F10, K70, X45, X65, Y15, Y90, Y91, E244, E512, G312, G621, G721, I426, K292, K860, O354, P043, Q860, T510, T511, T519, Y573, R780, Z502, Z714, Z721.

• Alcohol - deaths aged 45-74 years

Source: National Records of Scotland.

Definition: European age-standardised rates of death from alcohol related conditions amongst those aged 45-74 years. The definition of alcohol related deaths includes deaths where there was any mention of alcohol related conditions on the death certificate, rather than just as the main cause of death. The following World Health Organisation International Classification of Disease coding was used: ICD10 F10, G31.2, G62.1, I42.6, K29.2, K70, K73, K74.0, K74.1, K74.2, K74.6, K86.0, X45, X65, Y15; ICD9 291, 303, 305.0, 425.5, 571.0, 571.1, 571.2, 571.3, 571.4, 571.5, 571.8, 571.9, E860.

• All-cause mortality aged 15-44 years

Source: National Records of Scotland.

Definition: European age-standardised rates of deaths from any cause amongst those aged 15-44 years. Specific breakdowns for deaths from assault, drug related deaths and suicide are also provided, as the major causes of death for which there are large inequalities amongst young people. There may be some double counting in these breakdowns. The following World Health Organisation International Classification of Disease coding was used: Assault ICD10 'X85-Y09', 'Y87.1' ICD9 'E960-969'; Drug related ICD10 'F11-16', 'F19', 'X40-44', 'X60-64', 'X85', 'Y10-Y14'; Suicide (intentional self-harm + undetermined intent) ICD10 'X60-84', 'Y87.0' ICD9 'E950-959', 'E980-989',